Minerva anestesiologica
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Minerva anestesiologica · Dec 2012
Review Meta AnalysisA systematic technical review of the systems for the continuous positive airway pressure.
Continuous positive airway pressure (CPAP) is the application in the airways of continuous positive pressure, close to the positive end expiratory pressure. The two common available systems are by a continuous (high/low) flow system and by a mechanical ventilator. Aim of this study was to compare the mechanical performance of the CPAP systems in intubated and not intubated patients. ⋯ The continuous flow systems are able to maintain acceptable airway pressure variations during normal breathing. The most recent mechanical ventilators equipped with flow by systems compared to the first one, presented a similar or better work of breathing compared to the continuous flow systems due to the application of a little amount of pressure support. Although the use of a continuous flow is cheaper compared to mechanical ventilators, it does not allow a continuous respiratory monitoring.
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Minerva anestesiologica · Dec 2012
Multicenter StudyEffectiveness and predictors of success of noninvasive ventilation during H1N1 pandemics: a multicenter study.
The use of non-invasive ventilation (NIV) in acute hypoxemic respiratory failure (AHRF) due to H1N1 virus infection is controversial. In this multicenter study we aimed to assess the efficacy of NIV in avoiding endotracheal intubation (ETI) and to identify predictors of success or failure. ⋯ The early application of NIV, with the aim to avoid invasive ventilation, during the H1N1 pandemics was associated with an overall success rate of 47/98 (48%). Patients presenting at admission with an high SAPS II score and a low PaO(2)/FiO(2) ratio and/or unable to promptly correct gas exchange are at high risk of intubation and mortality.
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Minerva anestesiologica · Dec 2012
ReviewLimits and pitfalls of haemodynamic monitoring systems in liver transplantation surgery.
Cardiac output (CO) and other hemodynamic variables measured during liver transplantation are often obtained by pulmonary artery catheter (PAC) and in many centers by the transthoracic thermodilution method and/or intraoperative transesophageal echocardiography (TEE). Newer non-invasive technology, such as the PiCCO(®) system, the LiDCO(®) Plus monitor, and the FloTrac/Vigileo(®), have been proposed as more reflective of ongoing hemodynamic response to intraoperative manoeuvres. In contrast to the standard "semicontinuous" thermodilution method, which gives information over a set period of time, the new monitoring systems use a different time period or measure over a running several beat average. ⋯ However, as the use of these technologies has spread, so has the understanding of their limitations. This has led to an increased scepticism among the previously enthusiastic "pioneering" practitioners. Given the poor agreement reported in various studies on liver transplant surgery between PAC and the new "calibrated" and "uncalibrated"-derived measurements, multicenter trials aiming at evaluating the performance of the non-invasive methods in different hemodynamic conditions and dedicated monitoring-driven treatment protocols are necessary.
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Minerva anestesiologica · Dec 2012
ReviewBiomarkers for acute kidney injury in critically ill patients.
Acute kidney injury (AKI) is a common and frequently fatal illness in critically ill patients, with a high associated-mortality. Early recognition of kidney injury and prompt corrective measures may improve outcome. Finding an early, accurate and reproducible biomarker for AKI is a research priority. ⋯ However, their ability to predict worsening of AKI and need for renal replacement therapy (RRT) is not clear, and current available data are insufficient to recommend the use of these biomarkers routinely for clinical decision-making. Thus, using a combination of different urinary and plasma biomarkers and clinical observations, such as oliguria, may modify the clinical variability for therapeutic interventions, such as RRT initiation, and improve outcome. The purpose of this review was to summarize recent findings concerning biomarkers for AKI, especially in the intensive care unit setting, to highlight their strengths and weaknesses, and to determine their usefulness in clinical practice.
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Minerva anestesiologica · Dec 2012
Randomized Controlled TrialSoft tissue depression at the iliac crest prominence: a new landmark for identifying the L4-L5 interspace.
One of the most common approaches to identifying the L4-L5 interspace is using the iliac crest as a landmark. We propose a new landmark to identify the L4-L5 interspace based on the soft tissue depression palpable at the iliac crest prominence. The aim of this study was to assess the reliability and time saving when using this new landmark compared to using the iliac crest to perform a lumbar plexus block. ⋯ Use of the palpable soft tissue depression at the iliac crest prominence for performing a lumbar plexus block offered several potential advantages over the standard inter-iliac crest approach.